Adolesan varikosele güncel yaklaşım

Varicocele is a common vascular condition characterized by abnormal dilation of the pampiniform plexus due to venous valve insufficiency. Anatomical factors contribute to its higher prevalence on the left side. While the overall prevalence in the general male population is 15%, it rises to 35–80%among infertile men. The incidence increases during adolescence due to hormonal changes and testicular growth. The pathophysiology of varicocele involves testicular hyperthermia, oxidative stress, and venous stasis. Testicular hyperthermia negatively affects sperm production, while oxidative stress causes sperm DNA damage, threatening fertility. Venous reflux leads to the accumulation of adrenal and renal metabolites in the testes, resulting in cellular damage. Although adolescent varicocele is often asymptomatic, it can lead to testicular volume loss and infertility over time. Physical examination is the primary diagnostic method, but Doppler ultrasonography is necessary for detecting subclinical cases. Treatment decisions depend on the severity of the varicocele and differences in testicular volume. Various surgical and interventional treatment options exist, but there is no consensus on the best technique. Microsurgical approaches reduce recurrence rates and lower the risk of hydrocele formation. In adolescents, treatment is indicated in cases with a testicular volume difference >2 mL or 20%, pathological semen analysis, or symptomatic varicocele. Conservative follow-up involves regular ultrasonographic monitoring to assess testicular growth. The long-term impact of adolescent varicocele on fertility remains controversial. Some studies suggest that early treatment improves future fertility, while others report no significant benefit. However, early diagnosis and individualized treatment strategies are recommended to preserve testicular function and prevent future complications. Keywords: varicocele, adolescent, testicular function, infertility, microsurgery